Achalasia and Lap Band

I am so irritated. I had the lap band put in place in 2008. It would not wor****pt getting terrible esophogeal spasms, terrible acid reflux, etc. My original surgeon is in a different state. My new surgeon kept copious notes and sent me to a gastro doctor to do a test for Achalasia. He can't do a revision if I have achalasia. So I learned I am ''borderline" with Achalasia - which means I cannot have the vertical sleeve for some reason. The only reason he is willing to proceed with a revision to RNY is because the back or bottom of my esophogaus closes and opens correctly. The only real risk is I might have acid reflux issues but he said with my stomach being so small, it likely won't be that bad and I can take an antacid.

I am mad because my original doctor should have been thorough and not placed the lap band before making sure I was okay! The barium swallow would have shown that my esophogaus spasms terribly, and he didn't do anything about it! He placed the band, which made the condition worse! It has been pure hell!

I have no real point to my post other than be your own advocate and really research your surgeons. My original surgeon I believe just wanted to jump on the band wagon (it was 2008 where there were ads all over the tv for it) to make money. I don't think he did my pre-op examination well at all. My new doctor almost is too much in the other direction, but I am happy he is because I think it shows he is very careful and will not operate unless he has ruled out all problems.

So I now have to start the insurance process for a revision. I am really upset. I feel like I wasted time and money with the band. I worked SO hard with the band, to no avail. I feel like I wasted the last five years. Anyway, right now I am exercising and eating healthy to see if I can get this weight off on my own, but am also going through the insurance process because the weight is just not coming off very well. I am on the fence about the revision - but if my weight does not budge in the next few months I am going to proceed with the revision. It scares me because it is a huge procedure - and I chose the lap band because it was not as risky.

I also wanted to see - has anyone else delt with Achalasia with the band? Did you do a revision?

If you had no symptoms of achalasia pre-band, it's the band causing it.  My manometry almost 3 years out showed 0% motility, or end stage achalasia.  Get the band out, wait a few months and then do the manometry test.  You may have caught it in time.  Don't wait.  I progessed from mild achalasia symptoms to no motility in a matter of months.  I'm posting my complete band history for you to compare with your own.  The pains I got in the night early on were spasms....it's an early warning.  The esophagus is putting downward pressure on the lower esophageal junction and the band is putting upward pressure on it.  Eventually it just continually fails to open and you have band induced achalasia.  My esophagus is severely dilated and I have cardiac issues too as a result of the damage and scar tissue.  I cannot revise.  I've regained 25 lbs, my achalasia symptoms are much better, but I'm very unhappy with the outcome.  I had my band 3 years and one week to the day.  

 

My Band History

 

My first year with the band was trouble free...little did I know that following the rules, I would not avoid serious and potentially life threatening complications!

 

May 2010 Realize Band implanted, hiatal hernia repair, uneventful recovery

Aug 2010 fill 3 cc

March 2011 fill .5 cc

Summer 2011 began to have epigastric pain at night. these were esophageal spasms

Sept 2011 stomach virus

Sept 2011 pain upper right quadrant, duration 2-5 hours increasing, then subside quickly

Oct 2011 barium swallow, band fine, slow esophageal emptying

Oct 2011 upper abdominal ultrasound positive for gallstones

Oct 2011 gallbladder removal

Feb-May 2012 increasing GERD symptoms, nighttime epigastric pain radiating to shoulder, neck, jaw, back.  Palpitations gradually increasing in frequency more spasms + palpitations

May 2012 had cardiac work up, stress test, echocardiogram, negative for heart disease.  BP was elevated, so new drug Rx, resolved palpitations/hypertension.  Epigastric pain persisted.

June 2012 upper GI with barium shows stoma at band is nearly closed.  Barium drips through, but no stream.  Barium is backed up into esophagus.  PA removes all saline (3.5 cc confirmed, clear, no sign of infection).  Under flouro, barium is still in esophagus, emptying slowly.  PA and Radiologist are concerned, but decide after I drink 8 oz water to schedule me for follow up 5 @ weeks. only 3.5 cc in my 11 cc band....yet the stoma was nearly closed

July 2012 follow up, lost 4 lb.  still having problems eating anything fibrous, but able to eat, at least.  Barium swallow shows smaller than expected stream thru band, but also shows slow esophogeal motility, but not so slow as to require follow up.  PA states that since I'm tolerating food, losing and have a bit of a motility issue, she won't fill me, but cautions me to stay on the band diet and if I'm able to eat everything and quantity increases over 1 cup, to come in for another evaluation.

Oct-Dec 2012 In early October, became very intolerant to most foods and started having nighttime pain again, GERD symptoms.  Symptoms subsided for two weeks, then returned.  Taking PPIs for GERD, probiotics and experiencing extreme constipation. BMs only every 8-10 days.  Bloated miserable, having pain, feeling like food is stuck.  November, saw GI doctor and he ordered EGD, soft low fiber diet.  December EGD negative for Hpylori, celiac, erosion, Barrett's.  Prescribed Amitiza for constipation.  Antispasmodic for GI spasms. my GI tract was essentially shutting down, antispasmodic meds helped, but since the stoma was open, I was relieved.

Symptoms improved. slightly...I could eat very small quantities of moist meat, some veggies, yogurt, other soft foods.  No salad, fibrous veggies, etc.  I was regurgitating food most days, but not all meals.

Feb symptoms (intolerance of meals, feeling stuck, etc) returned.  Consult with GI doc, schedules GES.  Results normal gastric emptying times, but abnormal esophageal retention.  GI doctor follow up in 2 weeks.

March 2013: barium swallow:Dx achalasia, severe esophageal dilation due to LES failure to open in response to swallowing.  Discussed options for removal/revision and further testing. this was alarming...my esophagus was spasming wildly, my heart was racing and the looks on the PAs and radiologists faces said it all.  

April 2013:  esophageal manometry test to determine if achalasia is primary or secondary.  If secondary, band IS the problem and it will have to come out.  If primary, surgery may exacerbate the condition. My GI doctor was very alarmed at the result, 0% motility. 

Update: GI doctor has done all he can for me.  I'm scheduled in late May for evaluation with one of the top esophageal surgeons in the nation to discuss band removal, redoing my HH repair and looking to see if my vagus nerve has been damaged.

May 30: met with Dr Carlos Pellegrini, a world renowned esophageal specialist to determine the next steps.  He was appalled that no manometry testing was done prior to my HH repair/Lapband and that pledgeted sutures were used.  Apparently these are never used in areas where you don't want scar tissue to form, such as the esophagus.  He was confident that the combination of the two procedures is responsible for my achalasia.

May 31: call from Dr Khandewal, head of Bariatrics at University of Washington and my removal/exploratory lap is scheduled for June 7, pending pre authorization.

June 3: surgery is approved.  Preop appt on the 5th, surgery on the 7.

June 7: check in at 5:30am, I'm the first case of the day.  11am, wake up in recovery, told its out and lots of scar tissue removed.  Surgery duration was 3+ hours.  Feel like a truck ran over me, very nauseous.

June 8: I'm able to drink just fine, they're going to put me on full liquids.  Cream of wheat, yogurt and ice cream go down with NO regurgitation.  I'm discharged at noon...:)

June 13:  my entire GI tract has awakened.  I'm eating, swallowing, farting, pooping, no problem.  No regurgitation on a soft diet, no puking up my meals.

I'm having esophageal spasms and have redness around incisions, so have appt with Dr K on Tuesday.  Spasms aren't frequent, but are very painful, lasting 15 min or more.  Hyoscyamine + h20+ gaviscon help, but he wants to check me out.  Nurse thinks its the esophagus nerves waking up.  Lets hope!

 

High weight 290 lb

Surgery weight 281.5

Band emptying weight 225

Current weight 190

Goal weight 170

 

At all times my PCP, Gastroenterologist, Cardiologist and Bariatric Surgeon were in communication.  Procedures, records and test findings were shared. Copies of this history are scanned into my charts and updated.  

 

Preexisting IBSd. Hypertension, hyperlipidemia, sleep apnea, GERD.

Sacroiliac Joint Dysfunction/Spinal Stenosis

Left knee osteoarthritis-replacement recommended 

 

Still taking all medications I was taking pre-band + amitiza, antispasmodic and additional hypertensive drug  6/8 DC amitiza.

 

Did you have esophageal spasms before banding at all?  I had them immediately AFTER banding, but never before. 

I had the band removed, no revision. My only option was Duodenal Switch due to the horrible acid reflux I developed while banded (also something that I DID NOT have BEFORE banding.) The sleeve would have most likely exacerbated the problem. 

A lot of us feel like we wasted time and money with the band, believe me. It's a procedure that causes a lot of damage for a lot of us. 

I never had spasms prior to banding.  One of the problems with banding is that signs of trouble mimic conditions that can occur with anyone.  It's confusing for our non bariatric doctors.  My band doctor was more interested in covering his own ass than figuring out what was wrong.  I had two things that doomed my band to failure:

Hiatal hernia repair using pledgeted sutures and nissen fundoplication.  Pledgeted sutures are never used in this situation, since they cause the growth of scar tissue.  A nissen fundoplication is contraindicated in conjunction with bariatric surgery, especially in band and sleeve since they are both considered "high pressure".

My original surgeon was voted one of Seattles Best Doctors in his field of bariatrics.  Just goes to show that public perception is no guarantee of positive outcome.  I might have been ok if I never got a fill...but we will never know.

Sorry, Steph, I was trying to respond to the OP. I know you've had one heck of a time with the achalasia symptoms. (I changed my name, but it's me, NicM.)  :-) 

As posted above, your may not have had it and time of banding.  Banding has caused this problem as Steph can tell you.  Check out the failed band group and read the stories there.

Also, have they talked about removing the band and retesting.  Many surgeons have you wait 2-6 months in between removal and revision for the stomach to heal as advised by the ASMBS!  With issues like yours our has you wait 6-12 months before checking to see if you can revise.

My doctor does the revision where he takes out the band and performs the RNY all at the same time. He uses a Robot. I appreciate all the responses. If the band caused the problem then that is really upsetting too - in 2008 they just didn't have a lot of statistics out there and it was touted as a miracle surgery that was less invasive. Five years of hell has been five years too many. I just hope I can get approved for the RNY.

I'm seeing more and more people reporting complications following removal/revision at the same time.  Think long and hard about this decision.